Don't discount HRT's value

What would I do if I were a woman at the age of menopause and read the headline, "Breast cancer drop linked to decline in hormone therapy?"

I'd be scared as hell if I were already taking estrogen and I'd consider flushing it. But what should a menopausal woman do then if she has an overwhelming desire to kick her husband?

In 2002, a study of 16,000 women aged 50-79 showed hormone replacement therapy (HRT) increased the risk of breast cancer by 26%, stroke by 41%, heart attack by 29%, cardiovascular disease by 22%, and doubled the rate of blood clots.

These figures in a headline are misleading. Headlines failed to point out there were really only small increases in breast cancer, heart attack, stroke and blood clots among HRT users. For instance, there were only eight more cases of breast cancer and seven more cardiovascular problems for every 10,000 women per year of use.

On the plus side, HRT decreased the risk of fractures and cancer of the large bowel. Equally important, it cured menopausal symptoms like hot flashes, insomnia, severe irritability and stopped painful intercourse.

But this blockbuster report in July 2002 was bad news for the manufacturers of estrogen. During the next year, sales plummeted 38%.

The authors of a new study report that in the year following this announcement breast cancer rates decreased by 11.8% in women 50-69. These were the ones most likely to take HRT. In the over-70 group, rates fell by 11.1%. And for women who were under 50, breast cancer rates increased by 1.3%.

The study's co-author, Dr. Peter Ravdin, says: "Something went right in 2003 and it seems that it was the decrease in the use of hormone therapy." But is it really that simple?

When I read this report I was as dubious of the results as Dr. Robert Reid, professor of obstetrics and gynecology at Queen's University.

SLOW-GROWING

Breast cancer isn't like an infection that strikes suddenly. It's a slow-growing process that takes five years before a malignancy is large enough to be detected by mammography and up to 10 years before the lump can be felt. So Reid questioned how there could be such an immediate drop in cases in the few months after many women stopped taking HRT. It appeared to be an illogical association.

There is also a tendency for women to stop having mammograms once they stop taking HRT. This may result in fewer cancer diagnoses.

I have pointed out before that millions of women have been using estrogen for more than 60 years. One would think that if estrogen caused breast cancer, there would be a raging epidemic of breast cancer. This has not happened.

So what should menopausal women do? They must realize these studies are just "associations" linking HRT to breast cancer. When the sun rises in the morning and we get up in the morning, that's an association, but it means nothing.

I advise menopausal women without symptoms to forget about HRT. After all, if you don't have a headache, why take Aspirin? But if they do have severe symptoms, it makes sense to use HRT in the lowest effective dose for the shortest possible time.

Others who have been menopausal for several years may develop thinning of the vaginal lining from lack of estrogen. In this case local estrogen can cure this problem.

I'll be giving a series of talks during a Caribbean cruise in March 2008. If anyone is interested, please contact me.